Improving Local Care for the people of Swale

23 May 2019

The local NHS in Swale is investing around £2.6m over the next two years to improve care delivered in people’s homes and local communities, rather than in hospital.

It is the first time that local GPs, health and social care organisations, local authorities and the voluntary sector have all worked together to develop a plan to transform local care services for the people of Sittingbourne and Sheppey.

The Local Care programme is focusing on improving care for frail, older people and patients with complex health conditions to help them stay well and independent in their own homes.  By delivering joined-up care at home this will avoid a number of patients being admitted to hospital unnecessarily and enable them to be discharged from hospital as soon as they are medically fit.

Members of the Multi-Disciplinary Team for Sittingbourne West

Already a number of new services have been introduced over the past few months and health and care professionals are working together to improve the quality of care for our patients.

As an example, local GP practices now meet regularly in ‘multi-disciplinary’ teams with nurses, therapy staff, mental health, social care professionals and community navigators to share their expertise and deliver personalised, coordinated care to patients with physical, mental and emotional wellbeing needs.

In total, three teams have now been set up by GPs to cover the Sittingbourne and Sheppey practice population.

An extended team of Community Navigators has also been introduced.  Community Navigators help people access local services and community support and can link people to other specialist services including carers support, housing, benefits and activities within their local community.  This service has been jointly funded by NHS Swale Clinical Commissioning Group and Kent County Council.

A new Paramedic-led home visiting service is available for housebound patients, who can now be seen earlier in the day and receive the care they need, rather than waiting until the afternoon for a visit from their GP.   This service is already making a difference to patients and the GPs, whose workload is being freed up to see more patients in their surgeries.

The local Rapid Response service, which provides urgent specialist care at home for people living with a long term condition, is being extended to increase the number of patients it is able to support both within the community and those being discharged from hospital.  The service, which is provided by Virgin Care, focuses on providing rapid community care for patients whose health has deteriorated and are at risk of being admitted to hospital.  The service also provides timely intervention and support for those who have been discharged from hospital to regain their independence more quickly.

Dr Fiona Armstrong, Chair of NHS Swale Clinical Commissioning Group said:  “The new local care programme is very exciting as it gives us an opportunity to work differently and bring about real and lasting improvements to local care for the people of Swale.

“No-one wants to be in hospital for longer than necessary and we know that frail, older people could be better cared for at home if more support is available.  Investing in high quality care and services in our communities will reduce the need for people to go to hospital for treatment and help keep people safe and independent in their own homes for longer. This Local Care programme is a great example of how health and social care partners are working together to put patients at the heart of the service.”

For more information about improving Local Care in Swale, go to